2016-11-02T15:19:18-05:00 2015-12-31 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2015-01-01 480793267 DELTA DENTAL OF KANSAS INC % MICHAEL ELLIS DELT 3162641099 1619 N WATERFRONT PARKWAY WICHITA KS 67206 MICHAEL ELLIS CFO 3162641099 2016-08-15 true STEVEN L WEBB P00235405 3162652811 2015 2017-02-10 21:41:12Z MICHAEL ELLIS 1619 N WATERFRONT PARKWAY WICHITA KS 67206 297858148 false X WWW.DELTADENTALKS.COM X 1972 KS TO MAKE POSSIBLE AND FACILITATE A WIDER AND MORE TIMELY AVAILABILITY OF DENTAL CARE, THEREBY ADVANCING PUBLIC HEALTH AND DENTISTRY IN KANSAS, BY OPERATING A (SEE SCHEDULE O) 10 6 139 0 0 0 0 282481582 286645532 2270714 1044619 14370 8197 284766666 287698348 175871 1391096 0 0 9832596 10212201 0 0 0 269435599 272944734 279444066 284548031 5322600 3150317 66777769 67657881 13133101 11634989 53644668 56022892 X SEE SCHEDULE O false false 259842570 0 275179711 DENTAL BENEFITS (COVERED CHARGES) PROVIDED TO SUBSCRIBERS. DELTA DENTAL SERVED APPROXIMATELY 925,563 PEOPLE THIS YEAR. 8676817 0 11465821 THE PROCESSING OF DENTAL BENEFIT CLAIMS. 1391096 1391096 0 GRANTS PAID OUT TO 501(C)(3) ORGANIZATIONS. 269910483 false false false false false false false false false true true false false true false false true false false false false false false false false false true false true false false false false false true false false false false false false true true true true false true 29230 0 true 139 true false false false false false false X 10 6 true false false false true true true true true false false true true true true true true true true false X MICHAEL ELLIS 3162641099 1619 N WATERFRONT PARKWAY WICHITA KS 67206 DR LUCYNDA JANE RABEN DIRECTOR 0.97 0.1 X 18624 0 468 NANCY GWEN ZOGLEMAN DIRECTOR/CHAIRPERSON 1.04 0.2 X 17670 0 468 DR ALAN D MARCOTTE DIRECTOR/VICE CHAIRPERSON 1.01 0.1 X 14831 0 1359 DR PATRICK MORIARTY DIRECTOR 0.77 X 11777 0 906 DR BRICK RANDALL SCHEER DIRECTOR 0.48 X 13631 0 203 BRUCE WITT DIRECTOR 0.88 X 13313 0 1359 GARY YAGER DIRECTOR 0.7 X 12340 0 1359 ANGIE MCCLURE DIRECTOR 0.83 X 13284 0 1359 MARK PHILIPS DIRECTOR 0.83 X 12514 0 1359 RUTH TEICHMAN DIRECTOR 0.72 0.1 X 11577 0 1359 MICHAEL HERBERT PRESIDENT & CEO 33.8 6.2 X 385196 0 63765 MICHAEL ELLIS EXECUTIVE VP/CFO/TREASURER 37.7 2.3 X 235928 0 38235 NANCY UMHOLTZ SECRETARY 39.1 0.9 X 104908 0 20107 DEAN NEWTON MANAGING DIRECTOR & EXEC VP 36.5 3.5 X 292303 0 61743 ROBERT EBENKAMP VP INFORMATION TECHNOLOGY 39.2 0.8 X 206923 0 33018 JUNETTA EVERETT VP PROFESSIONAL RELATIONS 37.3 2.7 X 202313 0 41916 DR JON TILTON VP PROF REVIEW/DENTAL DIRECTOR 40.0 X 221714 0 43353 JEANNE HUGHES VP CLIENT SERVICE 31.3 8.7 X 185012 0 40769 KEITH ASPLUND VP PRODUCT MANAGEMENT 33.2 6.8 X 191703 0 30192 2165561 0 383297 23 false true false GAGE CENTER DENTAL GROUP PA 1271 SW WOODHULL ST TOPEKA KS 66604 DENTAL SERVICES 1750008 JENKINS LEBLANC PA 8226 MISSION RD PRAIRIE VILLAGE KS 66208 DENTAL SERVICES 1605852 WICHITA FAMILY DENTAL PARTNERSHIP 9339 E 21ST ST N WICHITA KS 67206 DENTAL SERVICES 1135941 MARTIN AND FRANKENBERY DDS PA 3101 N CYPRESS ST WICHITA KS 67226 DENTAL SERVICES 1330416 PALMER DENTAL GROUP 1425 GRAND AVE STE 101 HAYSVILLE KS 67060 DENTAL SERVICES 1032945 514 0 DENTAL SERVICES 524298 286645532 286645532 286645532 633016 633016 0 0 0 0 0 10571403 10159800 411603 411603 411603 0 0 0 OTHER INCOME 900099 8197 8197 8197 287698348 286645532 1052816 1391096 1391096 0 0 0 1351945 274163 1077782 0 6693640 2629790 4063850 795132 346041 449091 835434 381956 453478 536050 224111 311939 0 0 75031 75031 135000 135000 56983 56983 0 233630 233630 5229139 621617 4607522 1060156 1060156 1620817 1537582 83235 59914 43756 16158 0 242084 242084 403913 12966 390947 0 74743 6488 68255 304562 153499 151063 0 476146 240038 236108 108742 108742 CLAIMS 259842570 259842570 STATE PREMIUM TAXES 935991 935991 EQUIPMENT RENTAL & MAINT. 265260 223241 42019 CLEARING HOUSE EXPENSE 373454 357802 15652 1446599 687776 758823 284548031 269910483 14637548 0 782636 257756 4703508 5020061 0 0 5486909 6180038 0 0 0 0 0 0 0 0 351807 475342 12104765 4166519 7819854 7938246 39800246 39910707 7418987 7363135 0 0 0 0 413822 512596 66777769 67657881 7686380 6749046 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5446721 4885943 13133101 11634989 X 53644668 56022892 0 0 0 0 53644668 56022892 66777769 67657881 X 3150317 -377249 -394844 X true X true X true false 1401415 1401415 7332320 1730924 5601396 3371030 2435595 935435 7938246 INV IN SURENCY LIFE & HEALTH 7363135 F 7363135 0 CITY OF WICHITA - IRB(TAXABLE) 4398051 UNEARNED PREMIUMS 412919 UNEARNED RENT 73492 SUSPENSE ACCOUNT 1481 4885943 SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true BIG BROTHERS BIG SISTERS OF KANSAS CITY 1709 WALNUT ST KANSAS CITY MO 64108 436068464 501(C)(3) 12000 GENERAL SUPPORT BOYS AND GIRLS CLUB OF GREATER KANSAS CITY LEGACY CENTER 4001 BLUE PARKWAY STE KANSAS CITY MO 64130 436072065 501(C)(3) 25000 GENERAL SUPPORT CENTRAL PLAINS HEALTH CARE PARTNERSHIP 1102 S HILLSIDE WICHITA KS 67211 481200868 501(C)(3) 6000 GENERAL SUPPORT COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS 3011 N MICHIGAN PITTSBURG KS 66549 753002264 501(C)(3) 9521 FMV TOOTHBRUSH KIT GENERAL SUPPORT COMMUNITY HEALTH MINISTRY 407 ASH ST WAMEGO KS 66547 752974854 501(C)(3) 15258 8700 FMV TOOTHBRUSH KIT GENERAL SUPPORT DENTAL LIFELINE NETWORK PO BOX 4266 TOPEKA KS 66604 481188581 501(C)(3) 7900 GENERAL SUPPORT DOUGLAS COUNTY DENTAL CLINIC 2210 YALE ROAD LAWRENCE KS 66049 481216770 501(C)(3) 17106 GENERAL SUPPORT FIRST UNITED METHODIST CHURCH 330 N BROADWAY WICHITA KS 67202 481159633 501(C)(3) 14200 FMV TOOTHBRUSH KIT GENERAL SUPPORT FLINT HILLS TECHNICAL COLLEGE FOUNDATION 3301 W 18TH AVE EMPORIA KS 66801 481156696 501(C)(3) 150500 GENERAL SUPPORT HEALTH PARTNERSHIP CLINIC OF JOHNSON COUNTY 407 S CLAIRBORNE ROAD OLATHE KS 66062 481115529 501(C)(3) 150500 5992 FMV TOOTHBRUSH KIT GENERAL SUPPORT CATHOLIC CHARITIES OF NE KANSAS 1708 STEEL ROAD KANSAS CITY KS 66106 481181305 501(C)(3) 17237 FMV TOOTHBRUSH KIT GENERAL SUPPORT HUNTER HEALTH CLINIC 2318 E CENTRAL WICHITA KS 67214 480908355 501(C)(3) 7387 FMV TOOTHBRUSH KIT GENERAL SUPPORT JOHNSON COUNTY CHRISTMAS BUREAU 15560 W 110TH STREET LENEXA KS 66219 480884400 501(C)(3) 7962 FMV TOOTHBRUSH KIT GENERAL SUPPORT JUNIOR ACHIEVEMENT OF WICHITA PO BOX 780683 WICHITA KS 67278 480731855 501(C)(3) 10000 GENERAL SUPPORT KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT 1000 SW JACKSON STE 200 TOPEKA KS 66612 486029925 GOVT 35000 GENERAL SUPPORT KANSAS HEAD START 600 N KANSAS TOPEKA KS 66608 481195593 501(C)(3) 17155 FMV TOOTHBRUSH KIT GENERAL SUPPORT MAKE A WISH 125 S WASHINGTON ST STE 100 WICHITA KS 67202 480984820 501(C)(3) 10000 GENERAL SUPPORT MANHATTAN AREA TECHNICAL COLLEGE FOUNDATION 3136 DICKENS AVE MANHATTAN KS 66502 342064656 501(C)(3) 150000 GENERAL SUPPORT MARIAN CLINIC 1001 SW GARFIELD AVE TOPEKA KS 66604 481046905 501(C)(3) 14308 GENERAL SUPPORT ROSE BROOKS CENTER PO BOX 320599 KANSAS CITY MO 64132 510231573 501(C)(3) 10000 GENERAL SUPPORT SALINA HEALTH EDUCATION FOUNDATION 651 E PRESCOTT SALINA KS 67401 480858197 501(C)(3) 13106 GENERAL SUPPORT SEDGWICK COUNTY ZOO 5555 ZOO BOULEVARD WICHITA KS 67212 486120530 501(C)(3) 32500 GENERAL SUPPORT SEDGWICK COUNTY KS 1900 E 9TH STREET N WICHITA KS 67214 486000798 GOVT 18878 FMV TOOTHBRUSH KIT GENERAL SUPPORT SHELTERED LIVING 3401 SW HARRISON TOPEKA KS 66611 480779679 501(C)(3) 7158 GENERAL SUPPORT SOUTHWEST BOULEVARD FAMILY HEALTH CARE 300 SOUTHWEST BOULEVARD KANSAS CITY KS 66103 481067752 501(C)(3) 8527 GENERAL SUPPORT TURNER HOUSE CHILDREN'S CLINIC 21 N 12TH ST STE 300 KANSAS CITY KS 66102 481151382 501(C)(3) 15835 GENERAL SUPPORT UNITED METHODIST MEXICAN-AMERICAN MINISTRIES 310 E WALNSUT ST STE LL5 GARDEN CITY KS 67846 481049519 501(C)(3) 16006 FMV TOOTHBRUSH KIT GENERAL SUPPORT UNITED METHODIST OPEN DOOR PO BOX 2756 WICHITA KS 67201 480731995 501(C)(3) 50000 GENERAL SUPPORT UNITED WAY OF KANSAS CITY 801 W 47TH ST STE 500 KANSAS CITY MO 64112 440545812 501(C)(3) 28500 GENERAL SUPPORT UNITED WAY OF THE PLAINS 245 N WATER ST WICHITA KS 67202 480547688 501(C)(3) 8765 GENERAL SUPPORT UNIVERSITY OF KANSAS 1651 NAISMITH DR LAWRENCE KS 66045 481124839 GOVT 25000 GENERAL SUPPORT WICHITA CHILDREN'S HOME 7271 E 37TH ST N WICHITA KS 67226 480547706 501(C)(3) 15000 GENERAL SUPPORT WICHITA CHILDREN'S THEATRE 201 LULU WICHITA KS 67211 480979857 501(C)(3) 10000 GENERAL SUPPORT 33 SCHEDULE I, PART I, LINE 2 DELTA DENTAL OF KANSAS PROVIDED GRANTS TO PUBLIC CHARITIES AND GOVERNMENTAL ORGANIZATIONS TO FURTHER THE PURPOSE OF THE ORGANIZATION. X X true true X X X X X X false false false false false false false false false MICHAEL HERBERT PRESIDENT & CEO 251179 0 116778 17239 47166 0 16599 0 448961 0 0 0 MICHAEL ELLIS EXECUTIVE VP/CFO/TREASURER 197965 0 37286 677 26640 0 11595 0 274163 0 0 0 DEAN NEWTON MANAGING DIRECTOR & EXEC VP 203896 0 78587 9820 47654 0 14089 0 354046 0 0 0 ROBERT EBENKAMP VP INFORMATION TECHNOLOGY 167054 0 38446 1423 26351 0 6667 0 239941 0 0 0 JUNETTA EVERETT VP PROFESSIONAL RELATIONS 161440 0 38700 2173 26679 0 15237 0 244229 0 0 0 DR JON TILTON VP PROF REVIEW/DENTAL DIRECTOR 175973 0 41285 4456 29506 0 13847 0 265067 0 0 0 JEANNE HUGHES VP CLIENT SERVICE 172751 0 8872 3389 30232 0 10537 0 225781 0 0 0 KEITH ASPLUND VP PRODUCT MANAGEMENT 161824 0 29364 515 25345 0 4847 0 221895 0 0 0 SCHEDULE J, PART I, LINE 1A DELTA DENTAL OF KANSAS DID PAY FOR THE COMPANION TRAVEL FOR BOARD OF DIRECTORS AND LEADERSHIP TEAM MEMBERS WHEN THEY ATTENDED OUT OF TOWN BUSINESS MEETINGS. THE COMPANION TRAVEL AMOUNT WAS TREATED AS TAXABLE COMPENSATION AND IS INCLUDED IN THE BOARD OF DIRECTORS' 1099-MISC AND THE LEADERSHIP TEAM MEMBERS' W-2. SCHEDULE J, PART I, LINE 1A THE CHIEF EXECUTIVE OFFICER IS PAID A MONTHLY ALLOWANCE FOR MEMBERSHIP TO A COUNTRY CLUB. THE MONTHLY ALLOWANCE FOR MEMBERSHIP TO THE COUNTRY CLUB IS TREATED AS TAXABLE COMPENSATION AND IS INCLUDED IN THE CHIEF EXECUTIVE OFFICER'S FORM W-2. DR LUCYNDA JANE RABEN DIRECTOR 141835 PAYMENT OF DENTAL SERVICES false DR ALAN D MARCOTTE DIRECTOR 130905 PAYMENT OF DENTAL SERVICES false DR PATRICK MORIARTY DIRECTOR 181429 PAYMENT OF DENTAL SERVICES false DR BRICK RANDALL SCHEER DIRECTOR 134504 PAYMENT OF DENTAL SERVICES false SCHEDULE L, PART IV THE DIRECTORS LISTED IN PART IV ARE ALSO PARTICIPATING DENTISTS WITH DELTA DENTAL OF KANSAS. AS A PARTICIPATING DENTIST, DELTA DENTAL OF KANSAS PAYS THE DIRECTORS LISTED IN PART IV FOR THE DENTAL SERVICES THEY PROVIDE TO OUR SUBSCRIBERS IN THE NORMAL COURSE OF THEIR BUSINESS. FORM 990, PART I, LINE 1 NON-PROFIT PREPAYMENT DENTAL SERVICE PLAN. FORM 990, PART III, LINE 1 TO MAKE POSSIBLE AND FACILITATE A WIDER AND MORE TIMELY AVAILABILITY OF DENTAL CARE, THEREBY ADVANCING THE PUBLIC HEALTH AND THE SCIENCE AND ART OF DENTISTRY IN THE STATE OF KANSAS, BY ESTABLISHING, MAINTAINING, AND OPERATING A NON-PROFIT PREPAYMENT DENTAL SERVICE PLAN OR PLANS IN THE STATE OF KANSAS. FORM 990, PART VI, SECTION A, LINE 1B BRICK SCHEER, LUCYNDA RABEN, PATRICK MORIARTY, AND ALAN MARCOTTE WERE ALL VOTING MEMBERS OF THE BOARD AS OF THE END OF THE ORGANIZATION'S TAX YEAR. THESE INDIVIDUALS WERE ALL INVOLVED IN TRANSACTIONS WITH THE ORGANIZATION THAT ARE REQUIRED TO BE REPORTED ON SCHEDULE L. CONSEQUENTLY, THESE MEMBERS HAVE NOT BEEN REPORTED AS INDEPENDENT. FORM 990, PART VI, SECTION A, LINE 2 MICHAEL HERBERT, MICHAEL ELLIS, DEAN NEWTON, DR. LUCYNDA RABEN, AND NANCY ZOGLEMAN HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. MICHAEL HERBERT, MICHAEL ELLIS, DEAN NEWTON, DR. LUCYNDA RABEN, AND NANCY ZOGLEMAN SERVE AS EITHER OFFICERS OR DIRECTORS OF SURENCY LIFE & HEALTH INSURANCE COMPANY, WHICH IS A RELATED FOR-PROFIT COMPANY. THE OFFICERS AND DIRECTORS DO NOT HAVE STOCK OWNERSHIP INTEREST IN THE RELATED FOR-PROFIT COMPANY. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS. THE MEMBERSHIP OF DELTA DENTAL OF KANSAS IS COMPRISED OF THE DENTISTS WHO HAVE CURRENT PARTICIPATING AGREEMENTS WITH DELTA DENTAL OF KANSAS. EACH MEMBER IS ENTITLED, AT EVERY MEETING OF THE MEMBERS, TO ONE VOTE PER PERSON, BUT NO MEMBER SHALL BE ENTITLED TO VOTE BY PROXY. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS ARE COMPRISED OF TEN (10) MEMBERS, FOUR (4) OF WHOM ARE ELECTED BY THE MEMBERSHIP AND ARE AMONG THE CORPORATION'S PARTICIPATING DENTISTS, TWO (2) ARE APPOINTED BY THE GOVERNOR OF THE STATE OF KANSAS, AND FOUR (4) ARE APPOINTED BY THE COMMISSIONER OF INSURANCE OF THE STATE OF KANSAS. FORM 990, PART VI, SECTION A, LINE 7B ANY PROPOSED CHANGES TO THE BY-LAWS ARE SUBJECT TO MEMBER APPROVAL. THE BOARD OF DIRECTORS ARE COMPRISED OF TEN (10) MEMBERS, FOUR (4) OF WHOM ARE ELECTED BY THE MEMBERSHIP AND ARE AMONG THE CORPORATION'S PARTICIPATING DENTISTS, TWO (2) ARE APPOINTED BY THE GOVERNOR OF THE STATE OF KANSAS, AND FOUR (4) ARE APPOINTED BY THE COMMISSIONER OF INSURANCE OF THE STATE OF KANSAS. FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES THE FORM 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S ACCOUNTING PERSONNEL. ANY QUESTIONS OR COMMENTS ARE ADDRESSED AND ANY NECESSARY CHANGES ARE MADE. THE FORM 990 WITH ALL RELATED SCHEDULES IS THEN PROVIDED TO THE ENTIRE GOVERNING BODY FOR REVIEW PRIOR TO FILING. FORM 990 PART VI, SECTION B, LINE 12C THE CHAIRPERSON OF THE BOARD AND THE GOVERNANCE COMMITTEE MONITOR AND ENFORCE OUR CONFLICT OF INTEREST POLICY. EACH DIRECTOR, OFFICER, AND KEY EMPLOYEE OF DELTA DENTAL OF KANSAS ANNUALLY FILES A STATEMENT REGARDING CONFLICTS OF INTEREST WHICH EXIST, OR WHICH MIGHT BE EXPECTED TO EXIST, WITHIN THE UPCOMING YEAR. THE STATEMENT DISCLOSES AS FULLY AS POSSIBLE THE NATURE OF POTENTIAL CONFLICTS AND THE NATURE OF THE DIRECTOR'S, OFFICER'S, OR KEY EMPLOYEE'S INTEREST IN THE POTENTIAL TRANSACTION. ALL STATEMENTS ARE REVIEWED BY THE PRESIDENT AND CHAIRPERSON AND MAY BE CIRCULATED TO MEMBERS OF THE BOARD OF DIRECTORS. EACH DIRECTOR, OFFICER, AND KEY EMPLOYEE AGREE TO ANSWER ANY QUESTIONS ABOUT POTENTIAL CONFLICTS THEY MAY HAVE. IF A CONFLICT IS IDENTIFIED, VOTING MAY BE RESTRICTED. FORM 990, PART VI, SECTION B, LINES 15A & 15B THE DELTA DENTAL OF KANSAS PROCESS FOR DETERMINING COMPENSATION FOR THE CEO, OFFICERS, AND KEY EMPLOYEES DOES INCLUDE A REVIEW BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. DELTA DENTAL OF KANSAS HAS CONTRACTED WITH A CONSULTING GROUP TO PROVIDE COMPENSATION STUDIES FOR OUR POSITIONS. THE CONSULTANT USES PUBLISHED MARKET DATA SOURCES TO IDENTIFY THE RELEVANT MARKET FOR POSITIONS, WHICH ARE MATCHED BASED UPON THE DESCRIPTION OF DUTIES AND RESPONSIBILITIES PROVIDED. MARKET DATA IS USED AS APPROPRIATE FOR EACH POSITION, FROM LOCAL, REGIONAL, AND NATIONAL MARKETS. THEY PROVIDE A COMPLETE REPORT THAT DOCUMENTS THE FINDINGS OF THE MARKET REVIEW PROCESS FOR OUR POSITIONS AND THEIR RECOMMENDATION REGARDING THE GRADE LEVEL OF PLACEMENT OF THE POSITION. DELTA DENTAL OF KANSAS ALSO HAS A COMPENSATION COMMITTEE, COMPRISED OF SELECTED BOARD MEMBERS. ONE OF THE PURPOSES OF THE COMMITTEE IS TO REVIEW, REPORT, AND MAKE RECOMMENDATIONS TO THE BOARD REGARDING COMPENSATION OF ALL OFFICERS AND EXECUTIVE TEAM EMPLOYEES. THE COMMITTEE IS RESPONSIBLE TO MEET WITH THE PRESIDENT/CHIEF EXECUTIVE OFFICER ANNUALLY TO REVIEW HIS/HER PERFORMANCE AND EMPLOYMENT CONTRACT, MAKE RECOMMENDATIONS TO THE BOARD REGARDING THE PRESIDENT/CHIEF EXECUTIVE OFFICER'S ANNUAL COMPENSATION AND BENEFITS PACKAGE AND TO REVIEW THE PRESIDENT/CHIEF EXECUTIVE OFFICER'S RECOMMENDATIONS AS TO SALARY ADJUSTMENTS AND INCENTIVE PAYMENTS FOR OFFICERS, EXECUTIVES, AND SENIOR MANAGEMENT. FORM 990, PART VI, SECTION C, LINE 19 DELTA DENTAL OF KANSAS ANNUAL REPORT IS AVAILABLE TO THE PUBLIC THROUGH OUR WEBSITE, WWW.DELTADENTALKS.COM; OUR GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A ALL OF THE ORGANIZATION'S BOARD MEMBERS RECEIVE COMPENSATION FROM THE ORGANIZATION FOR THEIR SERVICES AS DIRECTORS. FORM 990, PART XI, LINE 9 206,827.00 MARK-TO-MARKET ADJUSTMENT NOT INCLUDED ON RETURN (601,671.00) EARNINGS FROM SUBSIDIARY NOT ON RETURN - SURENCY -------------- (394,844.00) KSDD PROPERTIES LLC 1619 N WATERFRONT PARKWAY WICHITA KS 67206 480793267 REAL ESTATE KS 622246 7260267 DELTA DENTAL SURENCY LIFE & HEALTH COMPANY 1619 N WATERFRONT PARKWAY WICHITA KS 67206 261969006 INSURANCE KS DDKS C CORPORATION -601671 9110671 1.00000 true false true false false false false false false false false false false false true true false true false false SURENCY LIFE & HEALTH INSURANCE COMPANY B 545820 COST SURENCY LIFE & HEALTH INSURANCE COMPANY N 165347 COST SURENCY LIFE & HEALTH INSURANCE COMPANY O 920233 COST SURENCY LIFE & HEALTH INSURANCE COMPANY Q 56039 COST